Podcast appearances and mentions of Louise Campbell

00:00:00 Surf's Up, Season 6, Episode 6.On April 23, 2024, our colleague and co-founder, Stephen Harrison, passed away suddenly. This week, Surfing the MASH Tsunami remembers Stephen with two of his closest associates and continues our annual MASH Drug Development roundtable held in his honor. 00:00:04:24 - A Deep Dive into Drug Development, Part 2The second portion of the Drug Development roundtable primarily focuses on three key issues. The first, uptake of resmetirom, starts with Naim Alkhouri discussing his experience in the Arizona Liver Health Clinics with over 650 patients in the year since resmetirom was approved and shifts to the various European panelists (Jörn Schattenberg, Louise Campbell and Sven Francque) estimating when it might be approved in their countries and how widely it might be reimbursed.  The second topic, incretin agonists, focuses on exciting prospects for other incretin agonists in development, as well as some semaglutide combination therapies. The third, NIT clinical trials, covers prospects that non-biopsy clinical trials might be approved sometime in the near future.00:16:20 - Remembering Stephen Harrison I: An Interview with Summit Clinical Research CEO Gail HinksonSummit CEO Gail Hinkson joins Roger Green for the first time on SurfingMASH to discuss her business partner. Gail discusses how the two originally formed Pinnacle Clinical Research and how Pinnacle led to Summit. She proceeds to discuss the current size and reach of both Pinnacle and Summit. Focusing on Summit, Gail describes the company as an Integrated Research Organization (IRO), highlighting its distinct role within the MASH firmament. In the final section of the interview, Gail discusses how Stephen's personality, goals, and vision continue to live on at Summit today.00:34:31 - Remembering Stephen Harrison II: An Interview with Naim Alkhouri Announcing That He Is Joining SummitNewly announced Summit Chief Academic Officer Naim Alkhouri joins this episode for a second time, but in a very different role. Naim discusses his personal history with Stephen and what he loved and respected about his "dear friend." He then makes a major announcement: he is joining Summit as Chief Academic Officer. He shares the many elements of this role, particularly his excitement that Summit can become the entity that educates a wide range of healthcare and commercial professionals on what MASH is and how it is treated. The scope of this vision, combined with what Gail discussed, portrays a level of energy, ambition and vision worthy of Stephen Harrison.00:55:55 - ConclusionAs part of this memorial week, Roger Green forgoes the usual business report, which will return next week.

This conversation is the opening segment of SurfingMASH's April discussion, in memory of Stephen A. Harrison, on drug development. In addition to co-hosts Jörn Schattenberg, Louise Campbell and Roger Green, panelists include hepatologists and key opinion leaders Sven Francque and Naim Alkhouri. This opening discussion focuses on exciting advances in one drug class (FGF-21s) and, more broadly, on exploring ways to treat cirrhosis. As Naim points out in his opening comment, these two issues— cirrhosis as a challenge and FGF-21s as a possible solution path —intersect in clear and exciting ways. He notes that the FGF-21 efruxifermin has been reported to have significant improvement in patients with cirrhosis, while the FGF-21 pegozafermin has shared positive results in a small cohort of patients. He also notes that a third FGF-21, efimosfermin alfa, has results in advanced non-cirrhotic MASH that suggest potential for similar efficacy in patients with cirrhosis, but this must be studied and confirmed in clinical trials. He mentions that resmetirom may also be showing signs of efficacy in some patients with cirrhosis. The entire package, he says, is a "game changer."Jörn notes that we are having parallel advances in treatment for advanced, non-cirrhotic patients. Sven concurs and comments that we are seeing effects that are not strictly related to metabolic disease. There is exceptional power that we can demonstrate one-level regression in sicker patients. The three agree that, at the same time, we are seeing cirrhosis trials that will lead to outcomes data; outcomes trials in non-cirrhotic medications may not be far away.Roger asks whether we are making progress in treating patients living with decompensated cirrhosis. Sven discusses what we are learning about treating portal hypertension, which is an important benefit unrelated to fibrosis regression. Simply improving portal hypertension will have an impact on endpoints. Naim points out that some ongoing trials include patients with cirrhosis, including survodutide and belapectin. Louise notes it will require "great P.R." to reverse some of the current perceptions about cirrhosis, but that this is "great." Naim states that even today, we have "a lot to offer" patients with portal hypertension or other symptoms of decompensation. As he concludes, he notes that this is underappreciated today. 

In a rapidly changing job market, the traditional CV just doesn't cut it anymore. In this episode, Louise Campbell, Senior Manager of Smurfit Careers Network, shares essential insights on the evolving recruitment landscape—and what graduates need to know to stand out.

his conversation is the concluding segment of  SurfingMASH's coverage of the AASLD Emerging Trends Conference on the SLD Spectrum diseases: MASLD, MetALD and ALD. In addition to co-hosts Louise Campbell and Roger Green, panelists include EASL Secretary General Aleksander Krag, hepatologist Alex Lalos and Jenn Leigh Jones, Founder of the Society for Sober Livers Survival patient advocacy group.The conversation starts with Roger questioning whether it is a good or bad idea to conduct separate studies on medicines' effect on MetALD patients. He notes Anna Marie Diehl's presentation at the Conference, which suggested that regardless of organ, all cell senescence and death results from iron overload, and asks whether we should be studying this phenomenon. Aleksander agrees that important questions around iron exist and should be addressed in future research. He places this issue in context by noting that after decades of failed drug trials, SLD research has produced a string of exciting successes using different modes of action. The group turns to discuss cirrhosis, based on recent presentations from Akero Therapeutics for its agent efruxifermin. Alex notes that his quick read of slides revealed that some of the cirrhosis patients had fairly advanced disease. He expresses a high level of enthusiasm that the prospective MASLD therapies discussed in this meeting will be the third major advance during his career in medicine.Roger asks the group two closing questions: one lesson each panelist is taking from the meeting and one message they would like to share with listeners. The group members all land in a similar place: there is a spectrum running from MASLD through MetALD to ALD and we are learning how their commonalities and differences are the keys to developing better treatments and guidelines.

00:00:00 - Surf's Up! Season 6 Episode 1SurfingMASH kicks off our sixth season in our new format, with three major elements to each episode. This week's Roundtable and Newsmakers segments focused on two recent conferences that took a multispecialty perspective on the range of medical and psychological issues affecting steatotic liver disease (a new concept specialty: steatology.") Our Expert this week is our co-host Jörn Schattenberg, discussing the educational and conceptual challenges of readying Europe for the EMA approval of resmetirom later this year.00:03:58 - Introductions and GroundbreakersHost Roger Green describes the new v2.0 format. He introduces the guests for this month's Roundtable discussion of the AASLD Emerging Trends conference: co-host Louise Campbell, hepatology KOL and EASL Secretary-General Aleksander Krag, Alcohol Use Disorder and Alcohol Liver Disease patient advocate and Sober Livers patient support organization co-founder Jenn Leigh Jones, and clinical hepatology Alexander Lalos. 00:15:46 - Roundtable: Highlights from the AASLD Emerging Trends Conference, Part 1The first portion of our Roundtable focuses on the emerging recognition throughout hepatology that MASLD, MetALD and ALD are best described as a disease spectrum, rather than discreet diseases. This has implications for the medical specialties involved in treatment and the entire way we look at this diseases.00:32:35 - Newsmakers: Arizona Liver Health Institute Chief Medical Officer Naim Alkhouri and Fatty Liver Alliance Founder Mike Betel Discuss the 2025 Deser Liver ConferenceNow in its fourth year, the Arizona Liver Health Institute's Desert Liver Conference has become a major multispecialty event on the Winter conference agenda. Arizona Liver Health Chief Medical Officer and hepatology KOL Naim Akhouri and patient advocate and Fatty Liver Alliance Founder Mike Betel join Roger Green to discuss the conference, including what makes it unique. Listen to Naim introduce a new description of the science of SLD.00:55:21 - Experts: SurfingMASH co-host and hepatology KOL Jörn Schattenberg joins Roger Green to discuss how Europe is preparing for the launch of resmetirom and his own focus on this issueOur third co-host, Jörn Schattenberg, could not join the February roundtable discussion. Here, he joins Roger to update listeners on his activities over the past six months. Most of the discussion centers around the necessary steps for Europe to prepare for the launch of resmetirom (anticipated to occur later this year), particularly given that the overall environment is more "siloed."01:11;15 - Wrap-up: Roger presents "the shortest Business Report ever"Roger discusses one continuing feature of Business Reports in the future from today and leaves all his other topics for next week.

Gone are the days where applying for a job meant printing a CV, putting on a suit and dropping it into an office reception. Louise Campbell joins us to discuss what's changed and how much of it is the fault of AI.

It's a move that will send a chill down the spines of many hybrid workers, Amazon boss, Andy Jassy, this week ordered his staff back to the office five days a week. Will it start a trend among other employers? Louise Campbell, head of Careers Network at UCD's Smurfit Business School, dropped in to discuss with Brendan

 Bulldog Drummond's Swiss wedding is delayed when a guest carrying newly developed artificial diamonds is murdered at a party before the wedding.   Original Release Date: March 18, 1938   Starring John Howard as Bulldog Drummond, John Barrymore as Colonel Nelson, Louise Campbell as Phyllis Clevering, E.E. Clive as Tenny

This week, Surfing the MASH Tsunami looks back on interviews Roger Green conducted during the EASL Congress itself. This conversation with SurfingMASH co-host and Tawazun Health Founder and Clinical Director Louise Campbell took place on the last day of the Congress.This conversation centered on three major topics addressed at the EASL Congress, each of which made Louise "quite enthusiastic."The first of these was the presentation of the new EASL/EASD/EASO Clinical Practice Guidelines and their practical implications (Season 5 Episode 21). Louise described this session as having "blown her mind" with its forward-thinking style and recommendations. She termed it a "leap of faith" that we all need to think differently about diabetes and obesity given how quickly incidence is growing. Her favorite items? The guidelines mentioned resmetirom even before it was approved in Europe.   Also, the guidelines described ways to use several drugs that have not been approved for MASLD to treat patients with other metabolic conditions that are linked to MASLD. Louise also expressed enthusiasm at which three organizations partnered on this document.Roger suggested that this aligned broadly with the various drug presentations in the Late Breaker and General sessions. Collectively, those presentations highlighted an array of drugs with different modes of action and strengths across the metabolic continuum.  More generally, the two agreed that we are looking at a world where, in just a few years, we will have multiple drugs, most with unique modes and all with specific patient targets.Roger asked whether Louise believes that over time, the diagnostic focus would stay with liver stiffness and CAP or switch to in-office PDFF. Louise suggested that in a world where clinical trials may not require biopsy, it would be difficult to build a sufficiently robust data set for any new tests.

This week, Surfing the MASH Tsunami looks back on interviews Roger Green conducted during the EASL Congress itself. This conversation with SurfingMASH co-host and Tawazun Health Founder and Clinical Director Louise Campbell took place on the first day of the Congress.Roger's first interview with Louise took place at the end of Thursday, the opening day of the formal Congress and the first day of research presentations and posters. She starts by describing the "really nice vibe" of the meeting, dampened by the fact that Stephen Harrison was not there, and is no longer with us.The first session Louise chose to discuss was the previous day's Patient Advocate session. To her, the key point was to learn a key question that every provider should share with every patient once a year. She mentioned briefly the one presentation from the day's General Session she was able to attend, a retrospective analysis of the predictive value of VCTE.Next, Louise discussed two sessions she attended that delivered powerful, somewhat novel messages. The first was a symposium sponsored by Novo Nordisk that looked at using the liver "to manage cardiometabolic side" through the liver "rather than focusing on liver disease." The second was the "Healthy Livers, Healthy Lives" presentation that presented "very startling figures" about healthcare costs and lack of productivity in the US and how and why India has targeted this disease aggressively. After Louise and Roger both commented on the building momentum in MASLD and mentioned why they believe this is happening, Louise noted how many conversations about AI and quicker population detection were occurring despite the lack of ability to act on these today. This let Roger recall his major takeaway from the Preview episode (S5 E17), which was the emerging importance of data development and large datasets. He mentioned a paper from the Karolinska Institute that Hannes Hagstrom discussed in that episode.

Co-chairs Shira Zelber-Sagi and Mike Betel and panelists Tom Marjot and José Willemse, all from the EASL Congress session "Patient Experiences in Clinical Settings," join Louise Campbell to discuss ways that socioeconomic and psychological issues impact the dynamic of the physician-patient consult, and, as a result, often patient adherence to therapy.This conversation starts with Shira asking Tom whether he addresses diet with his patients and, more importantly, whether he does so in the context of socioeconomic challenges, such as not recommending food that is too expensive for the patient. Tom says "Yes" to the first part, about diet and nutrition discussions and encouraging all patients to adopt a more healthy lifestyle, but, he says, not enough about socioeconomic issues. He feels that may be changing, though, based on the increasing discussion of food insecurity at conferences. The two agree that sensitivity in the topic is growing and needs to grow more in the years ahead, and also that while they are tailoring their discussions to address these issues, they can do more. Shira has begun to simplify her recommendations: fewer foods and less preparation time. Tom agrees this is a good idea.  Tom notes that he is focusing more these days on unemployment, social isolation and what he describes as social "unmet needs." He cites figures that 80% of the patients in a liver clinic have unmet needs and that improving social engagement can affect health. Mike asks whether the providers consider mental health, particularly given how important behavioral support is to treatment. Does Shira or Tom recognize mental struggle when the patient is sitting in front of them? Tom says this is an excellent question and identifies the three items patients in large studies say they seek in this realm: (i) education, (ii) reduction of stigma, and (iii) better psychosocial support. Mental health challenges are linked to unmet needs which, again, are linked to poor liver health. Tom believes the UK system does a good job of identifying this issue at the primary care level. Shira agrees this is important and, in her case, involves using quiet, probing questions in a sympathetic tone.   Louise asks whether Tom or Michael have observed MASLD-specific patient support groups in their regions. Both report that there are liver support groups, but nothing yet as specific as MASLD. 

Co-chairs Shira Zelber-Sagi and Mike Betel and panelists Tom Marjot and José Willemse, all from the EASL Congress session "Patient Experiences in Clinical Settings," join Louise Campbell to the need for resources that allow MASLD patients to access shared experience programs and holistic MASLD support programs. This final conversation focuses on shared experience and holistic MASLD support programs. It starts with Tom suggesting that shared experience is a pivotal factor in patient support groups and patient-based supportive care. He goes back to viral hepatitis, where many of the patients had common background challenges related to the disease. In viral hepatitis, patients who have been treated successfully become integrated into the care community. Nothing like that happens in MASLD at this time. Louise comments this would be particularly useful due to stigma around the disease, stigma that successfully treated patients have overcome.  Louise points out that Michael makes extensive use of shared experience videos, such as this month, when he invited patients to follow him on a "30-day glucose challenge." Michael says that he gets unsolicited notes about how helpful the approach is, along with diet recipes. He agrees with Tom that a viral hepatitis model might provide help here.  Mike discusses the idea of metabolic disease support programs that take a more holistic approach and place MASLD in a broader, multi-disease context. Shire likes the holistic approach as well, including a focus on mental health. Tom agrees with the basic approach, commenting that the multitude of possible issues is what makes MASLD so tricky.  As the conversation wraps up, two final themes emerge: (i) physicians must be actively curious in exploring each patient's needs if therapy is to succeed, and (ii) joint goal setting is an excellent strategy for driving incremental changes in behavior.  

This week's vault comes from our first episode with Shira Zelber-Sagi. She and Ken Cusi joined us during US Thanksgiving Week 2022 to discuss nutrition and behavioral issues related to MASLD. The episode's original writeup explains:Surfing the MASH Tsunami hosts its first episode dedicated to nutrition and NASH with distinguished guest, Prof. Shira Zelber-Sagi. Alongside this rich discussion are Ken Cusi, Jörn Schattenberg, Louise Campbell and Roger Green.This final conversation starts with Jörn  recalling Shira's statement that “diet is every day.” He notes that for patients whose serious medical issues are related to poor diet and lifestyle choices, behavior and diet can play an integral role in improved patient self-care and overall health. Roger highlights that a combination of medications and self-management can be a powerful, reinforced and effective treatment solution. This leads Shira to provide a step-by-step vision of how to work with patients on improving bad habits. In the end, she notes, clinicians and leaders need to appreciate the importance of policy in supporting clinical goals. The conversation continues with the group discussing what Louise calls “fun facts” about common unhealthy foods. For the final question, Roger asks the panelists for one piece of advice to be utilized by providers seeking to push behavioral change in their patients. Surf on for their key takeaways. 

Co-chairs Shira Zelber-Sagi and Mike Betel and panelists Tom Marjot and José Willemse, all from the EASL Congress session "Patient Experiences in Clinical Settings," join Louise Campbell to provide an overview of issues in physician-patient communication. The conversation itself has two elements. It starts with first-time surfers Tom Marjot and José Willemse introducing themselves to listeners. After that,  Shira starts by discussing the EASL Congress session within the context of a broader collaboration called "EASL Patient Synergies." This program led to the creation of the Patient and Advocate Forum as the EASL Congress, which led to this program. She says this year's program "worked" in developing "very interesting and fruitful and open dialog between patient and patient representatives and physicians," focusing on unmet patient needs and the roles various providers can play in addressing these. Mike shares one of his key takeaways: how fearful patients are when approaching physicians and how little information they share.   Mike recalls a comment Tom made during the session that if a patient ever told him, "What you just said hurt me or made me feel bad," that would have more impact on him than, as Tom puts it, "an entire weekend at a stigma workshop." Tom describes three levels at which to address patient stigma. Two of these, public policy and patient advocacy, are well known, but the third, improving direct physician-patient interaction, may be more vital and is underappreciated today. If patients provided direct feedback to Tom when Tom was communicating poorly, he says, he could adjust with the very next patient. Today, though, he doesn't get that kind of feedback.   Jose sees this as a two-way problem. Yes, most patients are fearful and do not share what they are thinking with the provider, but the reverse is true as well. When a patient shares feelings with a provider, the provider may not be equipped to handle it. She makes this point about provider insensitivity or failure to listen with two powerful vignettes.  Tom recalls Jose telling him in Milano that when the physician turns off the computer screen, it changes the entire dialogue with the patient. He has begun to do so, and it works!  Jose makes a couple of points about this. First, simply asking that patient, "How do you feel?" and engaging with the answer makes the patient more satisfied with the visit. Second, this speaks to the idea that physicians do not realize how important they are in the lives of their patients. 

Co-chairs Shira Zelber-Sagi and Mike Betel and panelists Tom Marjot and José Willemse, all from the EASL Congress session "Patient Experiences in Clinical Settings," join Louise Campbell to discuss some of the key dynamics shaping the physician-patient consult.This conversation starts with Mike asking Tom whether he reviews the patient's history before the visit. Tom says he does so because he considers preparation vital to a successful consult. That said, Tom notes the importance of being responsive to the conversation rather than using the chart review to decide the outcome of the visit. He provides some empathetic detail about how important the visit is to the patient and, as a result, how important that he be responsive as well as prepared.  José agrees, provides more color, and notes what she considers the most important question a physician can ask a patient: "How are you feeling today?" To José, asking that question just one time a year can change he entire dynamic of the relationship.  Tom then notes the scarcity of time and the double-edged demand this creates for each visit: plan in advance to use time as productively as possible, but once the patient is in the consult, give it all the time it needs.  After José makes a point about the importance of using language precisely, Louise joins the conversation to describe the consult as "like speed dating," with both sides having a scare few minutes to make a relationship that will be pivotal to the patient. 

Co-chairs Shira Zelber-Sagi and Mike Betel and panelists Tom Marjot and José Willemse, all from the EASL Congress session "Patient Experiences in Clinical Settings," join Louise Campbell to discuss strategies and questioning styles that can improve the dynamic of the physician-patient consult.This conversation starts with Tom stating that having multidisciplinary treatment teams would provide tremendous benefits in terms of being prepared for patients and fully responsive to the issues they are likely to raise. Jose agrees but adds that many countries have only a few nurses and no ability to create these kinds of teams.  Shira states that every physician should learn the principles of motivational interviewing. The key to this is asking open questions that allow the patient to respond fully without feeling judged or steered in a specific direction. This enables the patient to share unhealthy behaviors, which they might not do if the physician admonished them in advance. Tom agrees with the positive tone, saying that so much of the physician's role is all about trying to enthuse the patient to take control of lifestyle factors.  Along a similar theme, Mike notes the importance of tailoring care and questions to the individual patient. He points out that while 10,000 steps/day might be a goal, for some patients, it will feel so unattainable as to be demoralizing. Shira points out that an open question would start by asking the patient what goal is reasonable, and Jose follows by sharing an example of a patient who "hated" all exercise. José found a way to motivate the patient with simple, timely reminders that this was for the liver, and that the liver would be appreciative.  Louise adds that changes in activity if the patient can define them as "fun."

00:00:00 - Surf's Up: Season 5 Episode 23 During SurfingMASH's wrap-up interviews from the EASL Congress (S5 E19), Louise Campbell and Mike Betel mentioned a session Mike co-chaired on challenges in provider-patient communications. Today, the other co-chair, Shira Zelber-Sagi and panelists Tom Marjot and Jose Willemse join Louise and Mike to return to this topic.  00:13:34 - Discussing the EASL Congress sessionShira describes EASL Patient Synergies, a broad collaboration to develop open, solution-centered dialog focusing on what patients need in working with providers. Mike shares a key takeaway. 00:16:31 - Stigma in what doctors say to patientsThis section covers the issue of physician saying things they do not realize patients find hurtful. If the patient would share their discomfort, the provider could adapt on the fly. Jose sees this as a two-way problem: patients do not share feeling, but when they do, most providers cannot handle them. 00:19:40 - Sending signals of attentivenessThis section covers the positive impact when the physician does something simple like turning off the computer screen and the reasons why.00:21:06 - Preparing for a patient consultTom considers prior preparation and chart review vital to a successful consult. Panelists note how much more important the consult is to the patient compared to the provider.    00:29:23 - Structural improvements for patient consultsTo Tom, multidisciplinary treatment teams provide tremendous benefits in patient preparation and responsiveness, but Jose notes that many countries lack the number of nurses necessary to do so. 00:30:57 - Motivational InterviewingShira suggests that every physician learn the principles of motivational interviewing: asking open questions with no emotional valence. This enables the patient to share unhealthy behaviors. The panel agrees, noting that physicians can motivate and that they are most effective when tailoring to the individual.00:38:10 - Food insecurity as risk factorShira asks Tom whether and how he addresses diet with his patients and, more important, he does build socioeconomic factors into the decision analysis. Tom says "Yes" about diet and healthy lifestyle, but, he says, not enough about socioeconomic issues. They agree that awareness of the impact of food insecurity  is growing and needs to grow more. 00:41:10 - Assessing mental health and quality of psychological life The group considers the idea that a large majority of patients in a liver clinic have unmet economic or mental health needs, and discusses what to do to improve social engagement.  Tom identifies the three items patients in large studies say they seek.  The group discusses the idea that they see liver support groups, but  none are MASLD-specific. 00:46:03 - The value of lived experience in providing careThis section explores shared experience as a pivotal factor in patient-based supportive care, similar to viral hepatitis, where successfully-treated patients become integrated into the care community. 00:49:03 - Holistic metabolic disease support programs and wrap-upMike suggests that MASLD support programs take a more holistic approach that places MASLD in a broader context. Shira suggests adding a focus on mental health.  As the conversation ends, two final themes emerge: (i) physicians maximize success by being actively curious in exploring each patient's needs; and (ii) joint goal setting is an excellent strategy to drive behavior change.00:54:41 - Question of the WeekWhat structural or educational changes do you anticipate will improve provider-patient communication significantly, and will these changes require more from the provider, the patient or both?00:55:14 - Business reportInformation on future episodes plus a shout-out to Indonesia. 

In this closing conversation, Healthy Livers, Healthy Lives Chair Jeff Lazarus and Surfers Jörn Schattenberg, Louise Campbell and Roger Green discuss the upcoming United Nations General Assembly side event and consider ways listeners can support the "Healthy LIvers, Healthy Lives" coalition.Jeff discussed this impact on global care when the World Health Organization develops and releases a global health sector strategy. One key goal in public health is to lobby for a MASLD strategy. To that end, Healthy Livers, Healthy Lives is holding a side event at the United Nations General Assembly meeting in mid-September.  00:40:41 - Presenting MASLD to politicians One challenge in educating policymakers about MASLD is that people do not die from MASLD. One recent example: policymakers did not respond to the spread of SARS-CoV-2 until COVID-19 produced massive numbers of deaths. When asked, Jeff draws the chain from MASLD to MASH to cirrhosis and end-stage liver cancer and notes that we are already seeing MASLD as a leading cause of liver transplant. Roger suggests that Jeff reframe the issue to be about how many people die with MASLD, not from MASLD. Jeff believes this simple change may change the dialogue.  00:43:06 - How listeners can support this initiative Roger asks Jeff how listeners can support the Healthy Livers, Healthy Lives initiative. Jeff suggests that we all be careful to name the disease and let people know how easily MASLD can be identified and treated. For those who work in related areas or help set policy for their organizations, make sure that MASLD is included and, whenever possible, linked to diabetes, obesity, and other relevant metabolic conditions.   00:44:58 - LiverAIM and exit. As his closing comment, Jeff discusses LiverAIM, the largest European Commission-funded liver project in 26 years. (Jörn and Maja Thiele, who is leading the 100,000-person randomized clinical trial, discuss this in Episode 15.) Roger commits to producing an episode on LiverAIM this fall.   After Jeff departs, Jörn restates the importance of working with colleagues like Jeff who can systematically develop public health approaches and drive policy change from the top down. Roger agrees that a top-down approach can be extremely valuable, but may have limits in primary care. He suggests that professional organizations also need to bring allied health providers into the dialogue. 

In this week's episode, Jeff Lazarus discusses the idea that the MASH community, including patient advocates, live in a "bit of a bubble," where the clinicians with whom they interact are part of the MASH community. Last year's ICER Public Comments session exposed them to an FDA Advisory Board of hepatologists...and it was a very different experience. Last year's conversation notes reveal what happened and the advocates' reactions:In March 2023, Jeff McIntyre (GLI) introduced a draft report from the Institute for Clinical and Economic Review (ICER) on resmetirom and obeticholic acid for NASH. The Surfers dedicated an episode to expand on the contents, its shortcomings and potential implications with special guests Veronica Miller (Liver Forum) and Hannah Mamuszka (Alva10). In this conversation, SurfingMASH revisits the topic after a public comments session that took place last week. In doing so, patient advocates and friends of the podcast Mike Betel (Fatty Liver Alliance), Tony Villiotti (NASHkNOWledge) and Wayne Eskridge (Fatty Liver Foundation) join co-hosts Louise Campbell and Roger Green to share a range of impressions.Roger begins by asking the group how the word empathy fits into this discussion. Tony shares that he was upset by the majority viewpoint of 15 featured voting members on a number of different issues. For example, 40% of these voting members suggested that a drug approval would have no impact on a caregiver's life. Tony asserts the importance behind people needing to be aware of the impact of NAFLD/NASH not only on the patient, but also the families and those close to them. Speaking from personal experience, Wayne shares that he was perplexed on the document's position that NAFLD/NASH is not considered to be a progressive disease. This leads Louise and Roger to insert comments around the pricing and economic analysis surrounding the discussion. As the conversation winds down, Mike returns to the conundrum of the voting results. Listen on to hear why his reaction was, “I literally fell out of my chair.”

Healthy Livers, Healthy Lives Chair Jeff Lazarus joins Jörn Schattenberg, Louise Campbell and Roger Green to discuss some of the specific structural challenges that confront global MASLD public policy, along with some promising local activities. Louise observes that, in her experience, primary care practitioners appreciate the support that specialist nurses can bring in educating providers about the disease and patients about how to better support themselves. Jeff responds that these are good findings as individual cases, but to make major changes in the field, we need large-scale, top-down innovations. One thing that, oddly, works in MASLD's favor is that most patients with advanced MASLD will have concomitant diseases requiring involvement with other specialties. Today, teams are looking at system issues to find the largest, most intractable structural problems so that solutions can emerge. After that, "we'll start to see bigger and faster improvements in the field." Jeff talks about several positive things happening in New York. First, he mentions a New York Times article about junk food and how manufacturers target aggressive marketing to poor and marginalized populations, with the net result that these populations have processed and ultra-processed foods making up a large share of their diets. Also, a "visionary" health commissioner is creating a program, Healthy NYC, with the goal of increasing life expectancy by reducing specific diseases.MASLD is not part of the effort today but with clinician support. we can get there over time. Earlier, Jeff had commented about the ease of implementing the FIB-4 test. Now, Roger raises the issue again, this time mentioning that SurfingMASH guests from ex-US markets have mentioned that ALT is not a standard test in their countries and asks Jeff if MASLD is making progress here. Jeff discusses the debate around this issue.  

Healthy Livers, Healthy Lives Chair Jeff Lazarus joins Jörn Schattenberg, Louise Campbell and Roger Green to discuss the value of the updated EASL/EASD/EASO MASLD clinical practice guidelines and consider the role of Big Data in early MASLD screening. Roger asks Jeff whether he considers the updated MASLD CPG a step forward. Jeff praises the guidelines as "amazing" and suggests that one reason is that EASD and EASO are partners in drafting and promoting them.Roger's next question to Jeff addresses the idea that Big Data can provide a set of common variables that will outperform FIB-4 in predicting which patients are at high risk of MASLD or MASH, as Hannes Hagstrom discussed in Episode 17 this year. Jeff believes we can use more data than only the FIB-4 today but that, in the long run,we need better biomarkers to simplify the system. Jörn adds that having historical blood tests will allow for that kind of analysis, which should be superior to FIB-4. Jeff points out the challenge: not all variables are collected in each country. Bottom line: the solution must be simple and realistic to apply in practice in different countries.  

Healthy Livers, Healthy Lives Chair Jeff Lazarus joins Jörn Schattenberg, Louise Campbell and Roger Green to discuss why political will is so important in overcoming inertia and obstruction in global MASLD public health policy.Louise notes that she left NHS because of obstruction against earlier stage efforts to promote liver health and asks how to achieve these goals. To Jeff, it all depends on political will. He provides an example from viral hepatitis to prove his point.Roger asks how to motivate primary care practitioners who are overloaded with tasks they need to complete during short, overly scheduled patient visits.Jeff notes this is a challenge today, with a solution that lies in education that not only teaches about the disease but also stresses the cost of inaction. To Jeff, teaching FIB-4 to primary care and automating the algorithm to make it available in every electronic patient record is the minimum we should strive for today.Jörn focuses on the cost of inaction from a different direction: physicians who are afraid they will demoralize patients when they diagnose a disease with no available treatment. Jeff responds, "Do we not raise awareness because we don't have out-of-the-box solutions?" He goes on to describe different types of solution that might work for a patient, ranging from digital apps to linking patients to social agencies that can provide support and services. Jeff notes that "the field will need to change as we find more patients," due to increased demand on public health systems and social agencies.

Healthy Livers, Healthy Lives Chair Jeff Lazarus joins Jörn Schattenberg, Louise Campbell and Roger Green to discuss how the coalition came into existence and to describe two initiatves aimed at increasing early screening.Jeff starts the conversation by describing the "bit of a bubble" in which the MASLD community lives: great news and lots of excitement within, but very limited exposure to related metabolic specialties (endocrinology, primary care, cardiology) and limited awareness among the people and organizations that shape public health policy.Jörn adds that Jeff has been working for the last 4-5 years to create a multi-stakeholder coalition to promote liver disease to relevant professional societies and public health policy shapers. Jeff notes that patient advocates, clinicians, and professional societies each have a pivotal role to play in advancing liver care, particularly MASLD care.Healthy Livers, Healthy Lives is a coalition of four major professional organizations (AASLD, ALEH, APASL, and EASL) along with other partners, like the Indian National Association for the Study of the Liver (INASL), to raise awareness within the liver field and also other metabolic specialties. Jeff describes it as  "really trying to be an open, transparent, engaging, ambitious and aspirational coalition" with a light structure and just a few areas of focus over the next year: World LIver Day on April 19, the World Health Assembly, and the UN General Assembly.Louise asks about efforts to promote early screening that will help patients get care earlier in their disease progression. Jeff mentions two: a project to "double the diagnosis" over the next 3-4 years, and another project to identify all the concomitant conditions with sufficient cost of disease to merit screening everyone in that group. The latter will provide the kind of data to which public policy makers respond best.

00:00:00 - Surf's Up: Season 5 Episode 22  Jeff Lazarus joins Jörn Schattenberg, Louise Campbell and Roger Green to discuss Healthy Livers, Healthy Lives, a coalition of four major professional organizations (AASLD, ALEH, APASL and EASL) and other partners. This coalition works with other specialties to create global public health awareness and drive "top-down" solutions that are pivotal to stemming the MASLD Tsunami.  00:06:48 - The need for a MASLD public health coalitionJeff starts the conversation by describing the environment in which the MASLD community lives today: great news and energy within, but minimal exposure among related metabolic specialties and public health policy shapers. 00:11:55 -  Healthy Livers, Healthy LivesJeff describes the structure and goals of Healthy Livers, Healthy Lives.00:13:32 - Two initiatives to increase early screeningIn response to a question from Louise, Jeff mentions two efforts: a project to "double the diagnosis" over the next 3-4 years and another to identify all the concomitant conditions with sufficient disease cost to merit screening everyone living with that condition. 00:16:39 - Political will and structural changeLouise asks how we can overcome obstruction within the system to promote liver health. To Jeff, it all depends on political will, the energy that converts successful localized strategies into large-scale, top-down innovation. The solutions to the most significant, most intractable structural problems that evolve this way can drive "bigger and faster improvements in the field." 00:28:40 - Good things happening in New York In this context, Jeff shares how a visionary health commissioner in New York has created the Healthy NYC program to increase life expectancy by reducing specific diseases. 00:33:00 - The updated MASLD CPGJeff praises the updated MASLD CPG guidelines as "amazing" and suggests that one reason is that EASD and EASO are partners in drafting and promoting them.00:35:40 - Big Data-drive screening solutionsThis section explores whether and how Big Data can provide a set of standard variables that will outperform FIB-4 in predicting MASLD risk (see S5 E17). Jeff and Jörn identify the benefits and challenges of this approach.  00:38:38 - The upcoming U.N. General Assembly MASLD side eventHealthy Livers, Healthy Lives is holding this event at the U.N. General Assembly meeting in mid-September. The goal is to push the World Health Organization to develop and release a global health sector MASLD strategy.   00:40:41 - Presenting MASLD to politiciansOne challenge in educating policymakers about MASLD is that people do not die from MASLD. Sadly, large death counts produce public sector action, as we all saw with COVID-19. Suggestion: Reframing the issue as to how many people die with MASLD, not from MASLD, may make the story easier to tell.   00:43:06 - How listeners can support this initiative Roger asks Jeff how listeners can support the Healthy Livers, Healthy Lives initiative. Listen to hear Jeff's suggestions.   00:44:58 - LiverAIM and closing comments Jeff mentions LiverAIM, the largest European Commission-funded liver project in 26 years (see S5 E15). Jörn restates the importance of working with experts in developing public health approaches that drive policy change from the top down. Channeling Louise, Roger suggests that professional organizations need to bring allied health providers into the dialogue.   00:50:03 - Question of the Week Roger asks what listeners believe they can do in their own organizations and lives to support the goals discussed today.  00:50:36 - Business Report News on next week's session, Roger's office hours, and the Vault conversation.

In this closing conversation, updated MASLD CPG co-authors Frank Tacke and Elisabetta Bugianesi and podcast co-hosts Louise Campbell and Roger Green consider what the guidelines might foretell in changes in provider education, structure of patient visits and treatment in less affluent or medically advanced countries. The last set of questions begins with Roger asking what kinds of changes the authors would like to see in the healthcare system.  Frank likes Louise's idea of cardiometabolic pathological nursing and, more broadly, motivating physicians and nurses to view MASLD holistically. Elisabetta envisions a world where not only are there multidisciplinary teams, but each physician asks what they can do for the "liver/kidney/metabolic alliance." Frank describes this as "like a dream" and would like a world where the patient comes to the hepatologist for a cardiac workout, endocrine workout, nutritional counseling and other holistic support. It would also help get the correct patients triaged in primary care or referred to specialists.  Roger asks whether Tumor Boards in oncology serve as a model for integrated metabolic disease treatment. Frank says in his institution, boards exist for cirrhosis patients but will never be realistic for the number of patients needing treatment. As the episode winds down, several issues emerge. Louise wonders how these guidelines might be used in less affluent countries or those with less advanced/resourced healthcare systems. Elisabetta stresses the importance of generating awareness. Roger asks how the guidelines will incorporate updates for future drugs and bariatric surgery data; Frank feels this will not be a particular challenge and cites the upcoming data on obesity drugs and the SPECIAL study as information that might drive updates. Frank also suggests that all listeners should download the guidelines (the link is listed on the Surfing the MASH Tsunami web page.) And with one final set of congratulations to the authors, the episode ends.  

For most of this conversation, updated MASLD CPG co-authors Frank Tacke and Elisabetta Bugianesi discuss key issues related to pharmacology and prescribing choices. At the end, the focus shifts to the guidelines' overall benefits and some new kinds of education they call for. The conversation starts with co-host Roger Green asking about key issues from the pharmacology section. Frank states that one benefit of the CPG is the clarity around the point that optimal treatment for a co-morbidity must involve thinking holistically about the liver in the overall metabolic context.Elisabetta notes that while no drugs are efficacious for cirrhosis, the document does report that some drugs are safe for these patients, although sometimes with adjusted doses.Frank concurs that the document provides guidance on managing patients with end-stage liver disease and also discusses how to manage cirrhosis and its various complications. Elisabetta notes that these can be the most difficult patients to screen for HCC because "the fat liver is sort of foggy."This leads co-host Louise Campbell to discuss a point that arises frequently on this podcast: the positive value of simply stabilizing disease through medication and lifestyle.Roger adds that many primary care physicians in the US find managing metabolic multi-comorbid patients confusing and frustrating. These guidelines, with an integrated vision of metabolic diseases and the idea that stabilization might be a sound strategy, simplified the perceived task.Louise suggests that these guidelines "pinpoint...a role of the potential future" for nurses who can support the entire cardiometabolic syndrome. As she points out, even hepatology nurses are "not good at fatty liver disease." This document might drive a curriculum for such a specialization.

This week's vault conversation looks back 17 months when Ken Cusi joined co-hosts Louise Campbell, Jörn Schatenberg and Roger Green to discuss the revised AASLD Practice Guidance that had been issued the previous week. At the time, here was SurfingMASH's summary of the conversation: Late last week, AASLD published new practice guidance on the clinical assessment and management of NAFLD. The Surfers convene with Ken Cusi, who contributed to the previous iteration published in 2018, to explore its key features and implications. The updated document reflects the many advances pertinent to any practitioner caring for patients with NAFLD. This conversation focuses on the impact this guidance may have on patients: will it make a difference and if so, how?Ken asserts his position that both patients and providers need to be educated on solutions available today. Measures range from effective diet modifications to bariatric surgery and anti-obesity drugs. Louise Campbell reminds us that not all patients interact with physicians and that nurses, dieticians, and other allied health professionals experience more numerous contact points in terms of co-morbidity management. She asserts that guidances and guidelines need to make an effective impression on the frontline professionals, caretakers and even the patients themselves. This prompts Ken to share some exciting news with regard to the ADA formally recognizing NASH as a problem associated with diabetes. He reveals that he is chairing a committee that will work to create a consensus statement on this subject through consulting an array of stakeholders. Notably, they are inviting the participation of dieticians, diabetes educators, pharmacy representatives, obesity management leaders, primary care representatives and hepatologists, among other groups. Ken expresses his optimism for the momentous energy and convergence of fields in an unprecedented effort to collectively combat Fatty Liver diseases. Jörn adds that such collaboration will drive stronger patient advocacy and better education about what specific questions they should be asking their treaters. 

In this conversation, updated MASLD CPG co-authors Frank Tacke and Elisabetta Bugianesi discuss some of the guidelines' key goals and issues surrounding the screening, diagnosis and management of MASLD patients. As the conversation starts, co-host Roger Green says that he, too, was impressed that all these adjustments were made within a month at the end of the process. Frank praises the "very engaged Delphi panel" that reacted and voted quickly, and fairly consistently.  He proceeds to discuss how the Delphi panel was formed. From here, the discussion shifts into its key focus: patients. Roger asks for high points in the discussion of screening, diagnosing and managing patients. Elisabetta starts by stating that the resmetirom approval is creating a great push for screening because physicians feel that there is something they can do to help their patients. She describes an approach that begins with FIB-4, proceeds to VCTE and offers two paths for patient management. This should help the system identify patients before cirrhosis or HCC in pre-cirrhotic patients.  Frank points out that this set of guidelines does not rely on biopsy for risk assessment, which he terms "a major breakthrough."  Co-host Louise Campbell lauds the document's approach to diet advice, specifically the broad range of diets that will make it valuable worldwide and for primary care physicians to work from.  Frank adds that the guidelines have adjusted thresholds and other "adaptations to the ethnic background of the individual." This included considering the socioeconomic factors of a target country.  

In this conversation, updated MASLD CPG co-authors Frank Tacke and Elisabetta Bugianesi explain how the guidelines process benefitted from the close collaboration between EASL, EASD, and EASO.  The conversation starts with Elisabetta conveying the "big advantage" that came from this collaboration. The presence of the three organizations conveyed the need to create a common way to manage patients with MASLD, many of whom live with diabetes and obesity. The guideline also used the new nomenclature, which highlighted the metabolic root of the disease.Frank notes that the three societies have their own approval processes, which led to increased rigor from having to meet three standards. He concurs that the collaboration and approach strengthened the guidelines by putting the liver in the broader context on the disease.After co-host Roger Green notes how much more complete this is than the previously released clinical care pathway documents, co-host Louise Campbell asks whether the guidelines will increase the profile of liver disease in other specialties. Elisabetta refers to Ken Cusi's view that "it takes time," but points out two reasons for this integration to be smoother: (i) "you can't hide cirrhosis" and (ii) diabetes and other components of the general metabolic syndrome are pivotal risk factors not only for cirrhosis, but also HCC.Frank had been concerned at first that the name change would "lose the other societies," but the reverse was true: putting "metabolic dysfunction into the center of disease definition" links overall cardiometabolic risk to liver disease. Further, the guideline has a chapter on prevention and case-finding strategies that are relevant to primary care and diabbetology or endocrinology practices.Earlier in the episode, Louise commended the guideline for including resmetirom even before its approval in Europe. Frank thanks her, and notes that the decision to add resmetirom came after US approval and was included within the month before the guidelines were released, similar to discussion of how some glucose-lowering drugs could help treat cardiometabolic comorbidities.

Two of the co-authors of the upgraded MASLD Clinical Practice Guidelines,  Elisabetta Bugianesi and Frank Tacke join Louise Campbell and Roger Green to discuss the guidelines. The theme for the conversation is "introductions". First, the audience is introduced to co-authors Elisabetta Bugianesi and Frank Tacke, neither of whom has Surfed the Tsunami before. Both Elisabetta and Frank have unusual answers to the "one thing our audience would not expect about you if you didn't tell them" question, although in very different ways. After this, the Surfers and guests begin the process of introducing us to the updating process. Frank Tacke describes when the idea to upgrade arose, where it came from, and the two mechanisms, co-authors and Delphi panels, that became the foundation for the upgrade. 

00:00:00 - Surf's Up: Season 5 Episode 21 One important session at the EASL Congress 2024 involved the presentation of the new MASLD Clinical Practice Guidelines. CPG co-authors Elisabetta Bugianesi and Frank Tacke join Louise Campbell and Roger Green to share their perspectives on the guidelines' development some key recommendations.  00:09:36 - Revising the guidelines Roger asks the co-authors to describe the process that led to the 2021 decision to revise the guidelines. EASL was the initial driver; EASD and EASO joined the process. They formed a committee of 15 leaders and assembled a Delphi panel of 46 individuals from different stakeholder communities.  Elisabetta describes the "big advantage" of this collaboration: it conveyed the need for a common way to manage co-morbid patients with MASLD. To Frank, this approach strengthened the guidelines by putting the liver in the center of metabolic disease. Louise asks whether the guidelines will increase the profile of liver disease in other specialties. Elisabetta says "it takes time" but says that the nature of cirrhosis and HCC might make this easier.00:19:07 - Adding resmetirom before approvalEarlier, Louise praised the inclusion of resmetirom in the guidelines, Frank notes that this section was added to the guidelines within a month before their release and praises the "very engaged Delphi panel" that reacted and voted quickly.  He proceeds to discuss how the Delphi panel was formed.00:23:24 - Major issues in screening, diagnosing and case-managing patientsElisabetta starts by saying that resmetirom's approval created momentum for screening. She says the approach identifies patients before cirrhosis or HCC in pre-cirrhotic patients. Frank points out "a major breakthrough": these guidelines do not rely on biopsy.  00:28:04 - Non-medical factors Louise lauds the document's the broad range of diets that will make the document valuable around the world . Frank adds that the guidelines have adjusted thresholds  adapted to the ethnic and socioeconomic background of the individual. 00:30:52 - Pharmacological issues in the new CPG Frank starts the pharmacological discussion noting that the CPG drives holistic thinking about the liver in a metabolic context. Elisabetta notes that while no drugs are efficacious for cirrhosis, the document does report that some drugs are safe for these patients, although sometimes with adjusted doses. 00:33:39 - Screening for cirrhosisFrank concurs that the document provides guidance on managing patients with end-stage liver disease and also discusses how to manage cirrhosis and its various complications. Elisabetta says that HCC can be hard to find in a fatty liver. 00:36:36 - Cardiometabolic nursing as a future training and specialtyLouise suggests that these guidelines "pinpoint...a role of the potential future" for nurses who can support the entire cardiometabolic syndrome. This document might drive a curriculum for such a specialization.00:38:48 - What adjustments would you like to see in the healthcare system?The last set of questions begins with Roger asking what kinds of changes the authors would like to see in the healthcare system.  The discussion revolves around a "cardiometabolic" perspective but in terms of nurse training and the care provided in a hepatologist's office. 00:43:18 - Winding downAs the conversation winds down, each panelist offers a final comment or question.00:47:59 - Question of the WeekRoger asks how readily listeners believe the guidelines will be implemented, and which sections will be easiest and hardest to implement. 00:48:32 - Business ReportThe next EASL Congress review episodes, starting office hours, and a vault discussion from 2023's clinical care pathway document. 

00:00:00 - Surf's Up: Season 5 Episode 19During EASL Congress 2024, US-based Roger Green, conducted interviews with Mike Betel, Louise Campbell (twice) and Sven Francque from Milano. These interviews focused on the major MASLD themes and presentations at the event. 00:04:14 - Conversation with Mike Betel beginsOn Wednesday, the first afternoon of the meeting, Mike Betel joined Roger from the convention center. The first part of the conversation centered  on the Patient Advocate session that Mike chaired with Shira Zelber-Sagi. The session's goal was to discuss barriers to addressing unmet needs in a clinical setting and explore potential solutions. Mike's key takeaway: patients around the world are having challenges getting personal attention and time from their treaters. The rest of this interview touched briefly on other sessions Mike attended. 00:15:23 - First conversation with Louise Campbell Roger's first interview with Louise took place late on Thursday. She described the "really nice vibe" of the meeting, dampened by the fact that Stephen Harrison is no longer with us.The first session Louise chose to discuss was the previous day's Patient Advocate session. To her, the key point was to learn a key question that every provider should share with every patient once a year. She briefly mentioned the one presentation from the day's General Session she was able to attend:  analysis of the predictive value of VCTE.00:19:53 - Philosophically important presentationsLouise discussed two sessions that delivered powerful, somewhat novel messages. The first was a symposium sponsored by Novo Nordisk about how SLD treatment could "manage the cardiometabolic side...rather than focusing on liver disease." The second was the "Healthy Livers, Healthy Lives" presentation which presented "very startling figures" about SLD impact on US healthcare costs and productivity and how and why India has targeted this disease aggressively. 00:26:29 - Building momentum and energy around AI Louise and Roger both observed that momentum is building in MASLD and mentioned why they believe this is happening, 00:33:05 - Second conversation with Louise beginsTwo days later, Louise and Roger conducted a second conversation, which focused on her enthusiasm for the updated Clinical Practice Guidelines and their practical implications. 00:36:12 - CPG session implicationsLouise said this session had "blown her mind" with its forward-thinking style and recommendations. Her favorite point? The guidelines mentioned resmetirom even before it was approved in Europe.   00:44:07 - Thoughts about medicationsRoger suggested that CPG aligned broadly with the drug presentations in the Late Breaker and General sessions. Collectively, those highlighted drugs with an array of modes of action and strengths across the metabolic continuum.  00:46:09 - Thoughts about devicesRoger asked whether Louise believed that, over time, the diagnostic focus would shift from liver stiffness and CAP to in-office PDFF. Louise discusses why this might be difficult.00:51:48 - Conversation with Sven beginsThis conversation, which took place 90 minutes after the final gavel, started with Sven praising the "vibrant hepatology community" evident at the meeting. From there, the discussion covered the Clinical Practice Guidelines, major drug development presentations and other categories. The conversation is fairly short, but packed with information and insight. 01:06:42 - Question of the WeekRoger asks what kinds of support and education primary care will need to step into a leading role in treating SLD.01:07:13 - Business ReportPlans for the next month, growth of the SurfingMASH Community, a special surprise instead of the Vault.

This week's Vault looks back to the EASL Congress 2023 and includes Aleksander Krag, Sven Francque and all three surfers: Jörn Schattenberg, Louise Campbell and Roger Green. The focus of this conversation revolves around program design. The original conversation came with a robust description: This conversation starts with Roger's question to Sven around his role as Educational Councillor and the various educational opportunities embedded within the program. Sven first describes a postgraduate course that focuses on the link between NAFLD and cancer. He goes on to describe a plethora of activities which each embody different levels of education and participation for different stakeholder groups. Notably, he underscores the goal of broadening education to reach parties external to specialist hepatology groups. This is not only about raising awareness, but also engaging communities with the concept of liver health from a very young age. Roger asks what the balance is between virtual and onsite attendance and Aleksander suggests people are trending back to onsite participation. The group discusses why in-person attendance is especially positive for the previously described educational elements. From here Roger asks Aleksander and Sven for their lists of “3 things you can't miss” for different participating groups. First, he asks what's not to be missed for a recently minted transplant hepatologist. Next, he shifts focus to what's not to be missed for attending students.The conversation shifts to questions from Louise and Jörn which focus on how the program was put together. It becomes clear that this is a multifaceted event that combines the experiences of education, networking, science development and much more. Aleksander likens the meeting to a giant dinner party whereby the organizers are chefs who have taken a year to prepare an extravagant meal for thousands to enjoy. For the remainder of the session, Louise leans in on a comment Aleksander makes about allied health and points out that there are some very good and important sessions around health literacy.

In this excerpt from last July, Stephen Harrison shares results of the FASCINATE-2 study as part of SurfingMASH's larger coverage of exciting drug trials presented at The EASL Congress. The original writeup reads:This month, Surfing NASH embarks on a series of episodes dedicated to takeaways emerging from June's two major conferences: the 2023 EASL Congress in Vienna and the American Diabetes Association's 83rd Scientific Sessions meeting in San Diego. This is the second session focusing on drug development, and specifically, on several presentations for exciting drugs in development. In doing so, the Big Band of Surfers (Stephen Harrison, Jörn Schattenberg, Louise Campbell and Roger Green) are joined by Mazen Noureddin for a fascinating conversation which covers plenty of compelling clinical trial data.Jörn preludes this discussion by noting just how much important drug development research was released at this year's EASL Congress. Stephen proceeds from here to detail positive Phase 2b FASCINATE-2 clinical trial interim data for fatty acid synthase (FASN) inhibitor, denifanstat, as presented at EASL Congress by Rohit Loomba. In the process, Stephen elucidates why the idea of a FASN inhibitor is so exciting. It blocks de novo lipogenesis, which means it can have effects on inflammation and possibly direct fibrosis inhibition. Previously in Season 4, Episode 32, it was discussed why inflammation, which is tied to liver volume, might be a critical component to better understand for therapuetic development and the wider scope of liver health. From here, Stephen goes on to describe the trial, starting with basic design and sharing the MRI-PDFF and biomarker data that was presented at the EASL Congress. He finishes with safety and efficacy data and a general comment that the trial demonstrated, 'the drug is doing what it's intended.'

This conversation from #SLDThinkTank 2024 focuses largely on ways to improve delivery of screening services to patients. Along the way, participants reflect on the value of having Rezdiffra approved in the US and on its way to approval in other markets. As the conversation starts, Mike Betel transitions from a broader discussion of prevention to note that there are 94 FibroScan devices for all of Canada. Even these 94 are severely underutilized! Maja Thiele states that having a drug in market will motivate stakeholders throughout the system to screen more aggressively because they feel having an approved drug will enable them to help patients better. Louise Campbell asks whether the vision around utilizing FibroScan better included more creative approaches to site of delivery. This leads the group to discuss what will be necessary to improve utilization of these machines. Specifically, Mike asks who will coach allied health providers and physicians to use NITs (specifically scanners) as a way to open broader conversations on liver health.Jeff says that the last few minutes of discussion provided a general flavor of what the Open Space session was like. and comments on why this kind of small meeting is the right design for thinking big and brainstorming openly. He notes the mandate to get "better bang for the buck." Mike says it was extremely helpful to have a large number of younger attendees. 

This week's vault looks back to SurfingMASH's Barcelona coverage in earlier years to identify one point we can use to evaulate progress in the field. In this case, we looked back one year to see that INCBCN focus on NITs was driven largely by work from NAIL-NIT.Specifically, the 2023 version of NIT coverage at #SLDThinkTank 2024 was a discussion of real-world data from NAIL-NIT. The original conversation has a robust description:Surfing NASH returns to review the 2023 Innovations in NAFLD Care Workshop (INCBCN) which concluded on 27 May in Barcelona. Conference founders and directors Jeff Lazarus and Jörn Schattenberg discuss highlights and takeaways of the event with Louise Campbell and Roger Green.This conversation captures the meeting in a broad sense by outlining its goals and reason for being. Jeff describes this year's emphasis on expanding the community of practice beyond hepatology. For example, friend of the podcast and co-host of our Rising Tide series, Ken Cusi, chaired a session on the role of endocrinology and diabetology in the early diagnosis and management of NASH. In Jeff's words, “We were trying to look at the liver more holistically and look at who else should be involved in a multidisciplinary approach.”The discussion shifts to a review of the NASH-NITs Real-World-Evidence Summit. Jörn suggests that moving forward, the Summit ought to be expanded and broadened. After Jörn comments on the positive experience of facilitating hands-on engagement, Louise offers her take. She underscores that FibroScan testing requires adequate knowledge and training to be well-executed with precision. The group goes on to describe in detail what made the Summit unique and how it might grow in the future.

#SLDThinkTank 2024 co-chair Jörn Schattenberg and SLD Think Tank co-chair Jeff Lazarus, participants Maja Thiele and Mike Betel and SurfingMASH co-hosts Louise Campbell and Roger Green convene to discuss #SLDThinkTank, a conference designed to innovate solutions for addressing large issues, many involving public health,  in conquering MASLD. 00:00:00 - Surf's Up: Season 5 Episode 15Standard lead-in, including brief quotes taken directly from the episode.00:02:45 - IntroductionOpening comments discussing the aggressive travel schedules of our guests. 00:04:02 - Meeting Maja Thiele and LiverAIMMaja introduces herself to our audience, including her "One Fact:" she has been a radio host in Denmark. Jörn mentions that Maja is about to start "the biggest randomized controlled trial in hepatology" through LiverAIM, an extremely ambitious project funded through the EU Innovative Health Initiative. 00:12:47 - GroundbreakerEach panelist shares one piece of good news from the previous week.00:15:38 - #SLD ThinkTank 2024 design Jeff provides background and rationale for the #SLDThinkTank 2024 design, going back to an initial meeting in 2019 and the first two years of INCBCN (S4, E13 and E23; S3, E18 and E 24).  The event included five sections, two workshops and an innovative concept called Open Spaces. Jörn provides color about how Open Spaces actually worked. 00:20:13 - Participants' experiencesMaja praises Open Spaces, which she describes as "especially fruitful" due to the diversity of attendees. After Mike seconds this comment, she describes her Open Spaces experience. 00:25:53 - Meeting highlights Roger asks participants to describe their highlights from the meeting. Jeff describes the paper(s) that will result from this meeting, lists the ten major issues the group developed for ending the SLD pandemic, after which he elaborates on a few of these.00:29:40 - The Magic Wand exerciseJörn: at the end of the first session, chairs gave participants a "Magic Wand" to achieve their goals. He notes a consensus that "we ha[ve] mechanisms and biomarkers," but face major public and policy challenges if we are to slow the MASLD growth rate meaningfully.  Maja notes the long timeline from research to implementation. 00:33:09 - Improving utilizationMike discusses prevention separate from treatment: There are only 94 FibroScan devices in Canada, and even these are underutilized. The group discusses what will be necessary to improve scanner use in a future world where having medicines motivates medical stakeholders.To Jeff, this discussion provided a sense of how the Open Space session worked and why this is the right design for big issues like "getting better bang for the buck." 00:43:59 - NIT Summit Jörn discusses the NIT Summit, which preceded the #SLDThinkTank. He sees this as a first step toward acknowledging that we need to train more people and find ways to train them better.  Jeff agrees.Maya describes Elliott Tapper's state-of-the-art talk on social media. Her takeaway: video is a valuable new format, especially for younger stakeholders. 00:47:39 - Wrap-Up QuestionsRoger asks the group what other topics from #SLDThinkTank 2024 to discuss before closing. No two panelists' answers are redundant.  Finally, Roger asks how non-practitioners can help drive wider awareness and action. Again, answers vary widely.  00:55:45 - Question of the WeekRoger asks listeners to describe "one way that making better use of the tools we have today (diagnostics and medicines) can make a major dent in the MASLD pandemic."00:56:38 - Business sectionThis week's news on increasing interest in SurfingMASH, our first newsletter, the Stephen Harrison Memorial page, upcoming episodes and this week's Vault.

Manal Abdelmalek and Naim Alkhouri join co-hosts Jörn Schattenberg, Louise Campbell and Roger Green to share personal memories of co-founder and former co-host Dr. Stephen Harrison. Naim Alkhouri starts the conversation by describing how he met his "friend and mentor," Stephen. He recalls coming to San Antonio in 2017 to work with a different research group and contacting Stephen. Stephen told Naim he had "made the wrong decision" by not joining his team instead. Nonetheless, Naim persisted, and the two began a rich, rewarding friendship and research experience, which Naim describes in greater detail.Jörn Schattenberg says that Naim's story resonates with him. Stephen "support[ed] younger people in the field," including Jörn when he was starting his career in Germany. Historically, there had been challenges in conducting clinical trials in Germany, but Stephen worked with Jörn to overcome these and create a stable structure and base for conducting MASH trials. Jörn notes that the relationship Naim described applies not only to the two of them, but also to many other young researchers. Manal Abdelmalek recalls meeting Stephen in the earliest days of MASH, when a few young researchers shared posters in a "dark corner" of an AASLD meeting. Manal was impressed by Stephen's energy, warmth, curiosity and confidence that what was then called NAFLD would be "big" someday. Louise Campbell recalls meeting Stephen in the early days of SurfingMASH and always being appreciative of his support for nurses and allied professionals and the role they play in patient treatment. She goes on to note that the SurfingMASH podcast's growth affirmed the vision that Stephen and Roger Green had when they started the podcast.Finally, Roger Green shares his story of meeting Stephen at NASH-TAG 2019 and being impressed with how his energy suffused the entire space. Roger goes on to describe the process by which he and Stephen started the podcast and decided to expand its scope. 

Manal Abdelmalek and Naim Alkhouri join co-hosts Jörn Schattenberg, Louise Campbell and Roger Green to reflect on the greatest professional accomplishments of co-founder and former co-host Dr. Stephen Harrison.Naim Alkhouri starts this conversation by describing the two prospective epidemiology papers Stephen co-authored at San Antonio Military Medical Center in 2011 and 2021, an innovative design that provided early estimates of the breadth of MASLD and MASH in an asymptomatic population. He goes on to discuss Stephen's work on FAST and other NITs and finishes by remembering Stephen's exceptional work in drug development, culminating in the recent FDA approval of Rezdiffra. Manal Abdelmalek starts her comments  by recalling that Stephen developed the BARD score and, years later, celebrated that it had been supplanted by better tests. After commenting on his impact in drug development, she describes him as "visionary" and says Stephen was "not a one man show. He thought about networks and collaborations and how to move a field forward with speed and agility." Louise Campbell also reflects back on the BARD score and the process by which Stephen came to accept that the nomenclature change was a necessary thing. She closes her comments by reflecting on his persistence and innovation in drug development and finishes with a Harrisonisms about the value of failure and learning in the development of the product WD-40.  Finally, Roger Green discusses how Stephen's desire to tear apart his failures and learn from them resulted in the landmark paper that challenged how biopsies were being read and interpreted in clinical trial design, and also agrees with an earlier comment from Manal about how innovative the original design for Pinnacle Clinical Research was.

SurfingMASH's last year-end interview with Stephen Harrison took place in 2022. Louise Campbell and Roger Green join Stephen to discuss a promising year in MASH drug development and the podcast itself. At the time, this was the description of the interview posted in Buzzsprout:In the Season 3 NAFLD Year-in-Review conversations series, Surfers Jörn Schattenberg, Louise Campbell and Roger Green embark on a string of interviews with a handful of Key Opinion Leaders who made headlines and advances in Fatty Liver disease in 2022. In this exclusive segment, podcast co-founder and former co-host, Stephen Harrison, joins Louise and Roger to discuss the year-in-review as recorded before Madrigal's breaking announcement of the Phase 3 MAESTRO-NASH results last week.From the outset, Stephen admits there were “a lot of pleasant surprises” this year, alluding to the multiple positive Phase 2 trial results among other recent press releases. He anticipates several exciting modes of action becoming available in the imminent future. The interview goes on to look at advancements made in methodology of interpreting liver biopsies, understanding the limitations of biopsy and degrees of mitigation in response to those shortcomings. Stephen also offers in-depth investigation into the uptake of NITs as conditional clinical trial endpoints, something he sees as a process whose momentum keeps growing and strengthening.Throughout this session, Stephen provides speculation as to what the promising new year holds for the Fatty Liver field. In his words, 2022 revealed “the most incremental advances in the field of NASH in the past decade.” He adds that, like this year, 2023 is primed to be pivotal. Surf on for the full-length, insight-laden interview with a remarkable physician and Principal Investigator making tremendous contributions to the pursuit of putting a major dent in Fatty Liver. 

Manal Abdelmalek and Naim Alkhouri join co-hosts Jörn Schattenberg, Louise Campbell and Roger Green to rshare some of their favorite "Harrisonisms" - words, phrases and verbal memes associated with co-founder and former co-host Dr. Stephen Harrison.Naim Alkhouri starts by stating two of his favorite Harrisonisms, two that SurfingMASH listeners know well: "is the juice worth the squeeze?" and "Keep It Simple, Stupid." He goes on to add one that never appeared on the podcast, "FAIL stands for First Attempt In Learning," which he used frequently in discussed failed clinical trials. Manal Abdelmalek  shares several phrases she describes as "words to live by." Two of these are "don't you don't take yourself too seriously " and "There will be failures. The worst ones possible are those that you don't grow and learn from." She discusses how human, approachable and down-to-earth Stephen was, and closes with a story about him ordering a hamburger and "American French Fries" at a gourmet restaurant in Paris because that was all he really wanted to eat. Louise Campbell shared a Harrisonism she heard for the first time at Stephen's funeral about the difference between wisdom and knowledge: "Wisdom was knowing that a tomato was a fruit, and knowledge was knowing not to put it in a fruit salad." She goes on to comment on the joy he took in living a life of service.Finally, Roger adds two favorites of his own: "the liver is the canary in the coal mine," and that when Roger heard Stephen ask whether the juice was worth the squeeze, he always followed it with "is the view worth the climb?" Roger goes on to tell a story about Stephen's older brother, Ken, responding personally to every social media post-mortem to Stephen he could find because it is what Stephen would have done, and Ken's comment about Stephen's basic humility and dedicating his accomplishments to "God's glory." Finally, Naim tells about story about Stephen's interest in wine and Naim's in shopping and how they merged in a single vignette about Stephen and his daughter Anna Lauren in Paris.

The sudden passing on April 23 of our co-founder and colleague Stephen Harrison sent shock waves throughout the global SLD community. This week, Manal Abdelmalek and Naim Alkhouri join Jörn Schattenberg, Louise Campbell and Roger Green to remember and pay tribute to an exceptional leader, role model and human being.00:00:00 - Surf's Up: Season 5 Episode 14Episode introduction, including brief quotes taken directly from panelists. 00:03:11 - IntroductionRoger introduces the podcast. The three key opinion leaders, Jörn Schattenberg, Manal Abdelmalek and Naim Alkhouri, discuss their fast-paced, high intensity travel schedules.00:04:41 - Groundbreaker: a special memory of StephenIn place of a traditional SurfingMASH groundbreaker, Roger asks each panelist to share a special memory of Stephen. In turn, panelists discuss how they got to know Stephen and/or the role he has played in their lives. Summaries cannot do the emotion of these recollections justice.00:17:30 - One Harrison accomplishment Roger asks the group each to describe an accomplishment that Stephen has left the field. Each panelists provided at least 2 or 3, with no redundancy.00:23:52 - "Harrisonisms" and wrap-up In closing, Roger asks panelists each to provide a favorite "Harrisonism." Answers varied, although every group member recalled Stephen's question, "Is the juice worth the squeeze."00:33:33 - Question of the WeekRoger asks how listeners feel their lives or work were affected by Stephen Harrison, either directly or indirectly. 00:33:56 - Business Report This week's news on our new newsletter, future conversations, and the Vault, plus more on how we plan to honor Stephen.

This vault conversation looks back to our coverage of International NASHDay 2023, the predecessor title to this year's Global Fatty Liver Day. Thursday, June 8 was International #NASHDay 2023 and the podcast hosted a special session featuring patient advocates Gina Villiotti Madison (NASH kNOWledge), Marko Korenjak (European Liver Patients'​ Association) and Michael Betel (Fatty Liver Alliance). With co-hosts Louise Campbell and Roger Green, the group shares both a positive and sobering discussion around the Fatty Liver public health epidemic and its impact on younger generations now and into the imminent future.Roger starts this conversation by asking Louise to provide more information about the U.K. Parliament debate that had just commenced. Louise notes that MPs from all parts of the UK participated and that they were extremely well-informed on childhood NAFLD and other issues. She notes that members told stories of their own weight loss and government promise to brief MPs on liver disease on an interim basis going forward. One MP said he did not like the term living with obesity, which is considered patient sensitive, because it implies that obesity is a permanent condition. This leads to Roger's closing question which asks each panelist to envision what their organizations' key 2024 International #NASHDay activities might be. While their answer are aligned with what they did for the International #NASHDay 2023, listen for some different twists and new directions.This is a particularly important and moving episode that captures a range of topics pertinent to the patient perspective and, more broadly, stepping up to NASH.

Jeff McIntyre uses the discussion between Louise Campbell and Mike Betel as a jumping-off point for discussing some of the larger care challenges and barriers associated with MASH patient care. Jeff says the previous conversation between Louise and Michael provides "a really great synopsis" of the challenges and barriers to patient diagnosis and care. He reports that the Global Liver Institute is planning to release its first "Best Practices in LIver Health Policy" report.  For GLI, these challenges are more complex due to the need to find solutions that will work in countries around the world.  He also states that GLI believes the system needs to be intentional not only about diagnosis but also health system follow-through. This requires patient access and country systems set up for success.  Roger raises the issue of having safe spaces for people to exercise in less developed countries. Louise recommends tier systems so that the solution for each country reflects the country's economics. Roger discusses a recent study showing a link between food insufficiency in 4-year-olds and MASLD and MASH later in childhood. Jeff describes the Stockdale paradox: policymakers cannot get caught up in the big picture without dealing with the short-term issues ahead of longer-term success. Jeff describes two US health policy cases that reflect the Stockdale paradox:  the VA's initial decision (later reversed) to require biopsy for Rezdiffra and lobbying by the giant food companies to have added sugar included in the list of attributes of healthy food. Louise describes "a big to-do" in the UK about children's teeth and access to dentists because poor dental health drives a 7x increase in the risk of liver cancer. She would like to see a generalized dietician who can work with patients on the range of metabolic issues. Mike says it "scares" him about where to start small. Louise gives an example of boiling water before dressing wounds and taking other health actions in Angkor Wat, which led to dramatic declines in diarrhea and the spread of many diseases. 

On April 23, the global MASLD community lost one of its giants when SurfingMASH Co-founder Stephen Harrison passed away unexpectedly. Co-hosts Louise Campbell and Roger Green and guests Jeff McIntyre and Mike Betel each share a memory of Stephen. Jeff McIntyre starts this conversation by remembering Stephen as a fellow Southerner and, in addition to his many professional accomplishments, a person who could cut through high-level discussions with a "pithy little West Texas saying" that would make a complex or abstract concept clear. Mike Betel starts his comments by talking about Stephen's older brother, Ken, who wrote personal messages back to every comment he could find on social media, which was a remarkable task in its own right. Mike discusses how often he heard Stephen speak and how many times he interviewed Stephen for various Fatty Liver Alliance posts or events. Mike concludes with a story about Stephen talking for five minutes while Mike's audio was malfunctioning and then doing a second take remarkably similar to the first. Louise discusses being on the podcast with Stephen for years and regrets that he will never cook her a deep-fried turkey. She recalls his hobby of building elaborate sand structures on the beach with his family while he ran around the world, putting a large dent in MASLD. Roger starts by describing the first time he saw Stephen at NASH-TAG 2019 and how his larger-than-life presence and exceptional energy suffused a room of 200 people. He continues by using a favorite "Harrisonism" about being thankful that they didn't stop after WD-39 because WD-40 was the 40th effort to create the product we know today, and comments that for Stephen as Principal Investigator, Rezdiffra was his WD-40. Finally, Roger says he "just lost it" when reading the Walt Whitman poem "O Captain, My Captain," which Scott Friedman posted on LinkedIn as a tribute to Stephen.After the personal comments, Roger says that next week's episode will be a tribute to Stephen from some of his closest friends in the global MASLD community.

Fatty Liver Alliance Founder and President Mike Betel and Global Liver Institute Vice President for Liver Programs Jeff McIntyre join Louise Campbell and Roger Green to preview the premier MASH event for patient advocates, now known as Global Fatty Liver Day, which falls on June 13.00:00:00 - Surf's Up: Season 5 Episode 13 Episode introduction, including brief quotes taken directly from panelists. 00:02:37 - Introduction/Remembering Stephen HarrisonRoger introduces the podcast. Each panelist shares a memory of Stephen Harrison.00:11:44 - Groundbreaker Each panelist shares one piece of good news from the previous week.00:15:18 - Jeff Discusses Global Fatty Liver Day Jeff starts by discussing how GLI came to its 2024 theme:  "Act Now. Get Screened." Roger comments that this will require health systems to expand in scale and sophistication and shares Naim Alkhouri's critique (Season 4, Episode 50.3) of the current approach. He asks if US reimbursement policy is sufficiently developed and what patients can do. Jeff replies, "Get Screened."00:25:46 - Fatty liver and obesity Jeff notes the popularity and widespread discussion around anti-obesity medications, which also have effects on MASH. He expresses concerns that all this will lead to reduced focus on the liver. 00:26:43 - UK and AUSLouise discusses activities in her two homes.  Rather than focusing on liver disease, she prefers "poor liver health," which leads to cardiovascular disease and extra-hepatic cancers. 00:31:10 - Scanning patients as educational toolMike asks Louise to comment on scanning as an educational activity. Louise discusses the ability to generate an effective description and activate conversation when she delivers scan results right at the time of the patient visit. She then discusses the next steps if the first one doesn't work.00:35:40 - Challenges and barriers for patients To Jeff, the previous conversation between Louise and Michael provides "a really great synopsis" of the challenges and barriers to patient diagnosis and care. He announces that the GLI is planning to release its first Best Practices in Policy report.  These challenges are more complex due to the need to find solutions for diagnosis and health system follow-through that will work around the world. 00:43:10 - Battles around healthy lifestyle policies Jeff describes two challenging US health policy cases: the VA's decision (later reversed) to require biopsy for Rezdiffra and giant food companies lobbying to include added sugar as a healthy food item. Louise links the sugar question to "a big to-do" in the UK about children's teeth and access to dentists because poor dental health drives a 7x increase in the risk of liver cancer and advocates for generalized dietician training. 00:47:56 - The liver as elephant Roger cites the parable of the blind people touching the elephant as a metaphor for a myopic view of liver health. He advocates teaching "the whole elephant" to healthcare professionals. Louise proposes an action point of "rule the liver out" before testing for related diseases. Roger suggests this is a dual mandate. For patients: Act Now. Get Screened. For providers, Rule the Liver Out. 00:51:21 - Initiatives for Global Fatty LIver Day and wrap-up In lieu of a final question, Roger asks panelists to describe one specific initiative that is part of Global Fatty Liver Day. Mike and Jeff each describe screening activities.00:58:13 - Question of the Week Roger asks what listeners can do in their work to support the two simple mandates: act now, get screened, and rule the liver out. 00:58:44 - Business ReportThis week's news on audience metrics, future episodes and this week's Vault conversation.

This wrap-up conversation about MASH Drug Development covers two issues: combination therapies with old drugs and using NITs to speed and smooth the path to approval.Louise Campbell starts this final conversation by asking whether we are paying sufficient attention to old drugs that might have value in MASH. She points to a recent study demonstrating that low-dose aspirin significantly affects liver fat and suggests that we are not thinking broadly enough about use of older agents in MASH. Jörn Schattenberg comments that without robust NITs, it will be difficult to prove these effects, particularly, as Roger Green adds, for a drug that will not produce sufficient revenue for BioPharma to conduct a larger trial.After a brief digression over whether we know how to shorten the time to drug approvals (short answer: not until we have better approaches to using NITs), Roger asks his closing question: how will having a drug approved affect the conduct of trials going forward? Answers vary and present a complex picture. You'll have to listen to learn

This conversation starts by focusing on the impact of concomitant metabolic therapies in MASH drug development and patient treatment and then moves on to explore some major implications of the earlier conversations. Roger Green begins this conversation by returning to the issue of metabolic drugs. Specifically, he mentions a recent tirzepatide Phase 3 trial that demonstrated efficacy against symptoms of obstructive sleep apnea. Louise Campbell points out that sleep apnea correlates highly with SLD as well as obesity. She suggests this is one more point proving that we need to educate more physician specialties on liver health and educate them more effectively. Will Alazawi agrees with Louise's comment, citing a talk he and a colleague gave at the Diabetes UK conference the previous week that was part of an academic session on liver disease, noting that the session itself was well-attended. Will emphasizes applauding Diabetes UK for arranging and promoting this kind of multidisciplinary academic session of MASLD and MASH. Roger shifts focus by asking what insights investors or other professionals who listen to the episode should take from this discussion. Jörn Schattenberg starts with the most important point: we now know how to get a drug approved. Considering other drugs in development, he adds that the drugs we are studying now may be potent enough to overcome issues that challenged earlier agents. Sven Francque adds that in future years, prior use of incretin double-agonists and triple-agonists will change the nature of the MASH patient population and make drugs like Rezdiffra that have liver-specific modes of action more important and valuable.   

One theme in this week's episode involves different ways to use NITs in drug development and assessing the value of older drugs in MASH. This conversation, from our review of last September's FDA workshop on NITs, considers two additional roles that NITs might play in drug development. The conversation includes Jörn Schattenberg, Louise Campbell, Roger Green, and guest Laurent Castera. The original post has an excellent description:This conversation begins with a discussion of a point from a previous episode in 2022 about the difference between NITs to qualify patients for trials versus to evaluate the efficacy of drugs. This point stems from the idea that the way disease regresses may not be the same way it progresses. Laurent notes that NIMBLE and LITMUS have demonstrated important results with large data over the last two years. Jörn comments on the limits of using transaminase as a key NIT and Laurent replies by discussing a study over time that shows faster early declines on liver stiffness and slow declines over time as therapy might shift from reducing inflammation to regressing fibrosis. Louise shifts focus to ask about the relationship between kilopascal drops related to lifestyle change, specifically to ask whether these are false positives or real effects. Laurent notes that BMI is a confounder for liver stiffness and that CAP might help assess this issue. Finally, in response to a question from Louise, Laurent answers that we do not know about some of the key changes in test scores, and need to know more.Plenty more ideas are explored as this is both a fascinating and pivotal workshop which covers a range of topics on NITs with presentations by the some of the field's most innovative and knowledgable contributors. If you have questions or comments around the workshop, NITs, drug development or any other themes addressed in this episode, we kindly ask that you submit reviews wherever you download the discourse.